A 46-year-old man collapsed while training for a marathon. Paramedics were unable to revive him and he was declared dead after 30 minutes of resuscitation efforts in the emergency department. The family informed the doctors that the deceased was a registered organ donor. However, because he did not die in the right way or location as outlined by policies, he could only be a tissue donor, not fulfill his wish to donate organs, leaving his family and those waiting for transplants distraught. The case highlights the complex ethical issues around defining death and the barriers created by policies that can prevent willing donors from donating.

1. THE ETHICS OF ORGAN DONATION
Allin Varghese, Brenda Mayaka, Inas Mohamed

2. “A 46-year old man training for a marathon seemed in excellent
health yet suddenly collapsed. His training partner immediately
called 911 and initiated chest compressions. Emergency medical
services arrived within 3 minutes and placed an automated
external defibrillator (AED) that fired 2 times. There was no
return of spontaneous circulation. Paramedics continued chest
compressions and ventilation en route to your hospital. In the
emergency department (ED), you exhausted all resuscitative efforts
for 30 minutes and subsequently ordered termination of
resuscitation. When you notified the family, though distraught
over their unexpected loss, they informed you that the deceased was
a registered organ donor and request that his wish be honored.
They anxiously wait for your response..”

3. Outline
Demographics of organ donation
Ethical analysis of organ
donation
Legal analysis of organ donation
The uniform Anatomical Gift Act
Reflections and conclusions-
nursing implications (moral
distress).

4. Definition of Terms
UDDA- Uniform Determination of Death Act
UAGA- Uniform Anatomical Gift Act
DNDD- Donation after Neurological Determinatin of Death
DCDD- Donation after Circulatory Determination of Death
cDCDD- Controlled Donation done in controlled settings
uDCDD- uncontrolled Donation done outside the hospital and
emergency departments.

5. Criteria For Organ Donation
person has to be declared dead by circulatory determination
of death (DCDD)
person has to be declared by neurological determination of
death (DNDD)
person has to die in a controlled setting, and cannot die in
an Emergency Department, or outside the hospital- one of
the reasons there might be shortages in organ donations
consent for organ donation has and for removal of life
support has to be given.

6. Increase in Demand with Low
supply

7. Shortages of donors
12000 people die each year, or are extremely ill for transplants, and another 115,000 are on a wait list

8. cDCDD and uDCDD
• uDCDD is a program that was implemented in Spain and
France to resolve the problem of shortages in organ
donation, and has proved to be successful.
• difference between cDCDD and uDCDD is that the latter is
done even in uncontrolled settings like the emergency
room and outside of the hospital, while the former is in
controlled setings such as ICU.
• The USA is against such a program as it violates the Dead
Donor Rule.

9. The Dead Donor RuleThe dead donor rule states that a person’s vital organs can only be donated when they are declared dead,
either neurologically or circulatory.

10. Organ Donation Ethical Issues
IN THE NEWS

11. Parents of a young girl's wish to donate her organs
denied after she does not die quickly enough
following the removal of life support
A man who spent his life advocating for organ
donation finds himself brain dead. The family decide
they want to honor his wish. They donate his vital
organs before the removal of his life support. His
organs are denied....
A 21 yr old man who is an organ donor is declared
legally dead. his family unaware of his decision figh
to keep him alive, but unsuccessful..... "he does not
deserve to die like this"

12. Denver children's hospital's cDCDD program under
attack in 2008- hearts from children who were
declared dead started beating in recipients' bodies.
How come the hearts started beating in the
recipients’ bodies after the donor was declared
dead. Were they dead to begin with?

13. Denver’s children’s hospital defended their
decisions based on the fact that they followed
protocol. Other ethicists disagreed with this and
suggested the heart should be excluded from the
vital organs to be donated

14. Ethical Principles
Autonomy-implies that a person should be given
choices in regards to the situations involved in their
dying
Non-maleficence-protects the patient from more
harm. A patient can donate their vital organs for as
long as it does not cause further harm

15. Legal Analysis
The National Organ Transplant act (1984): this act provides for the establishment of a
task force on organ transplantation, organ procurement and transplantation network, and
authorizes financial assistance for organ procurement organizations (Westrick, S. J.,
Dempski, k., 2009).
The Omnibus Reconciliation Act (1986): this is an act that specifies standards and
protocol for organ procurement. Hospitals that are participating in Medicare and Medicaid
programs are needed to establish written standards to recognize organ donors. The
health care facility has to make sure that the potential organ donors are aware of their
options to donate or decline to donate organs. Secondly motivate discretion and
sensitivity with respect to the situations, views, beliefs of the families of the donors and
finally notify an organ procurement organization about the potential organ donors
(Westrick, S. J., Dempski, K., 2009).

16. Uniform Anatomical Gift Act
The act requires written documentation of the donors’ intention for
organ donation. One of the limitations of this act is getting consent
from minors and mentally disabled donors. The health care provider
gets the permission of family members in such situations. The
amendment included in the uniform anatomical gift act, 1987 version
has a controversial provision that gives permission to medical
examiners and public health examiners for removing body parts from
a cadaver if there is no knowledge about dead persons qualifying
relative objection. There are some other provisions in this act that
permits routine inquiry about organ donation for patients admitted in
the hospital. Also another provision allows hospital representatives to
talk to dying patients about organ donation.

17. Nursing Considerations
Nurses are always caught in the middle of ethical
dilemmas when taking care of patients nearing
death, and the families grieving, and also thinking
about the recipients’ family that are also
desperately waiting for a chance for survival for
their family member. It is documented that critical
care nurses always face emotional and moral
distress

18. Reflections and
Conclusions
Ethically, it is our duty as nurses to respect the body integrity and
human life of each patient we encounter. The process of organ
donation harvesting is a very complex topic for health
professionals involved in caring for a potential donor. Since it
mobilizes feelings, cultural beliefs, and religious values
regarding mortality and death, and nurses have to develop a
principled approach to support potential donors.

19. “You reluctantly tell the family of the marathoner who died
unexpectedly, “As of now, he may only be a tissue donor.” You
wonder whether you should explain that because our society cannot
agree on when the patient is dead and because he did not die in
theright way, either brain death or removal from life support, nor in
theright location, the ICU, he cannot fulfill his dying wish. “What
about his organs?” the family asks. Their words are gut wrenching,
reminding you of the incredible mismatch of needs, in which willing
donors cannot donate because of mystifying fears they are not
dead,
whereas those in need of transplants die on the ever-expanding
waiting list. You think about live donation risks that could be
prevented with a more rational understanding of death. Nonetheless,
you maintain your composure and say, “I’m sorry.”

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